Promotion of the health of rural women towards safe motherhood--an intervention project in northeast Thailand.

An intervention project focusing on the health of women in the reproductive age was conducted in three districts of Khon Kaen Province, northeast Thailand between 1991 and 1996. Main emphasis was placed on improving reproductive health, the nutritional status including the iron deficiency anemia (IDA) as well as iodine deficiency disorders (IDD), and the parasitic diseases liver fluke (Opisthorchis viverrini) and hookworm. For implementation a community based Primary Health Care approach was used including the training of health officials in health matters, primary health care workers and villagers as well as enhancing health education and the dissemination of health information. The health delivery system was encouraged to take appropriate actions such as in the treatment of parasitic diseases and the control of IDA and IDD. Monitoring was done on a regular basis. The outcome of the project was assessed by comparing baseline data compiled from a random sample of the target population with the results of the final evaluation. An attempt to compare results obtained from villages within and outside of the project area failed most probably because of spill over effects. A number of important indicators on family planning and mother and child health care improved during the time the project was implemented; this included practising family planning, and participation in antenatal care. Also the proportion of females becoming pregnant for the first time when 20 years or older increased. Child-raising also improved in that almost all females gave colostrum to their babies by this time. Almost 75% of the women breast-fed their children. Improvements occurred in the nutritional status as far as the micronutrients iron and iodine were concerned, however the overall nutritional status of females did not change, but a rather high proportion of females were found to be overnourished. The project failed in reducing abortion and the proportion of females becoming pregnant when they are 18 years old or younger. It was also not possible to improve the usage of postnatal care. As anticipated, the results achieved so far are most suitable in serving as a training ground and providing a favorable example to improve family planning, mother- and child health care, and also the general health of females in the region, particularly in neighboring countries such as Lao PDR, Cambodia and Vietnam.

Prevalence of abnormal glucose tolerance in Khon Kaen Province and validity of urine stick and fasting blood sugar as screening tools.

Three hundred and fifty-five individuals, 152 males and 203 females, aged between 30 and 74 years, were randomly selected in a two stage selection process from rural communities in three districts of Khon Kaen Province, Northeast Thailand. The prevalence of impaired glucose tolerance (IGT) and non-insulin dependent diabetes mellitus (NIDDM) in the rural area of Northeast Thailand were measured. In addition, the validity of the urine stick and fasting blood sugar as screening tools against the two hours glucose loading test as golden standard were determined. The survey was conducted in July 1995. The glucose loading test was performed on 277 individuals. IGT and NIDDM were classified according to current World Health Organization suggestions. Prevalence rates for IGT were 18.1 per cent and for NIDDM 11.9 per cent. No difference was found between males and females, also when controlled for age. NIDDM prevalence increased with age but IGT rates already were high in the younger age groups. This finding suggests that IGT precedes NIDDM in Thailand. The validity of the urine stick as a screening tool in communities was insufficient, with a sensitivity of less than 20 per cent. When using fasting blood sugar as a screening test, the sensitivity was close to 44 per cent and the specificity 90 per cent. It is concluded that the urine stick is not a useful screening tool and the method of using blood sugar concentrations for screening have to be improved before it can be applied within communities.